11-07-2025
Demand for Noninvasive Fat Reduction Is Plummeting
Huy Luong
This article is based on a piece that originally ran on Jolene Edgar's Substack, Aesthetics Unfiltered.
The American Society of Plastic Surgeons' (ASPS) annual trend-spotting report has arrived, plotting the popularity of plastic surgery and noninvasive procedures. Every year, it analyzes key shifts in aesthetic medicine—and never fails to provide a juicy surprise or two.
The 2024 installment that just came out had a few highlights: Demand for cosmetic interventions mostly held steady across the surgical and minimally invasive categories, without any major spikes. While facelifts and related glow-ups like brow lifts and lip lifts dominated on social media, the most popular plastic surgery procedures in ORs were actually butt and thigh lifts and, interestingly enough, cheek implants, each recording a three percent uptick from the previous year. In the nonsurgical realm, neuromodulators (like Botox, Xeomin, and Dysport) and hyaluronic acid fillers (such as Restylane and Juvéderm) claimed the top two spots, respectively. Next up, people were getting more skin resurfacing treatments (peels, lasers, microdermabrasion), which came in third, up six percent from 2023.
What caught my eye, though, was a far bigger number in the % CHANGE 2024 vs 2023 column: negative 40%. It's the data equivalent of a free fall, and it was attached to the number of noninvasive fat reduction procedures—CoolSculpting, Vanquish, Kybella, and the like—performed by plastic surgeons year-over-year. They fell from 745,967 in 2023 to 447,581 in 2024.
What's most surprising about the drop-off, according to some doctors, is the sheer fact that it took so long to transpire. When I posted on Instagram about the rapid decline, plastic surgeons replied with comments like, 'Finally!' and 'Thank god!' Consider the track record of these treatments—some are as famous for complications as results—and factor in the Ozempic phenomenon, and you can perhaps see why these methods for freezing or heating or otherwise killing fat cells have begun to fall from favor.
Noninvasive fat reduction procedures are down 40%, the data equivalent of a free fall.
Bob Basu, MD, a board-certified plastic surgeon in Houston and the president-elect of the ASPS, attributes what he calls the 'steep decline' to both the GLP-1 boom and what he sees as the modern patient's bang-for-buck mentality.
'The rise of GLP-1 medications for weight loss has fundamentally changed the landscape,' Dr. Basu says. By targeting visceral fat—'the deep intra-abdominal fat [cushioning our organs] that no plastic surgery or device can reach,' he explains—these drugs deliver wholly transformative results. And since people who lose considerable weight are typically left with loose, hanging skin, they're shifting focus to refining their shape and tightening their skin with both surgical nips and tucks as well as minimally invasive skin-tightening modalities, he says. (These can include radiofrequency treatments, like Renuvion and BodyTite.)
In addition to performing surgical lifts to remove excess tissue from the arms, thighs, breasts, back, and abdomen, 'we're very busy doing liposuction in patients who've lost significant quantities of fat with the GLP-1s,' says Darren Smith, MD, a board-certified plastic surgeon in New York City. Why would someone who's already slimmed down need lipo? 'These are very nuanced cases, where [the patient] has lost a bunch of weight, but there's still a fat deposit with a complex anatomy that requires a customized approach,' he explains. This person might want to remove stubborn fat—from, say, the hips or thighs—that persists even after they lose weight on a GLP-1, for example. Also, lipo is generally about contouring, not strictly debulking.
While nonsurgical fat-reducing treatments—which aim to destroy fat cells so the body can then eliminate them—'can be effective for small, localized areas,' notes Dr. Basu, 'they often require multiple sessions and don't address skin laxity or significant volume loss [that comes with taking a GLP-1].' He believes this puts them at a disadvantage with today's 'value-conscious' patients who, 'in the wake of ongoing economic uncertainty,' are more carefully weighing the risks and rewards of cosmetic procedures.
While every cosmetic intervention poses some degree of risk, CoolSculpting has made headlines for its complications. One of the more serious risks of the fat-freezing technology is paradoxical adipose hyperplasia (PAH), which is marked by fat growth in treatment areas. While PAH was first reported in 2014, it didn't achieve mainstream notoriety until 2021 when Linda Evangelista shared what she called her 'brutally disfigur[ing]' experience with CoolSculpting and sued the makers of the device for $50 million in damages.
In a time of economic uncertainty, patients are more carefully weighing the risks and rewards of cosmetic procedures.
A potentially devastating complication, PAH presents as abnormal bulges—usually hard, sometimes painful, and frequently shaped like the device applicator. Its victims typically see their treatment areas shrink as expected, but then, weeks later, grow bigger than they were pre-freeze. The only fix for PAH is surgery—energy-assisted liposuction and/or a tummy tuck—to address the fibrotic fat (a firm type of fat that can be challenging to remove) and restore normal contours.
The incidence of PAH is low, but thought by some to be underreported. 'While one review [of more than 2,000 CoolSculpting patients] cited [PAH] rates ranging from 0.05% to 0.39%—compared to the manufacturer's noted rate of 0.025%—even these values are likely artificially low due to underreporting and other factors,' says board-certified New York City plastic surgeon Alan Matarasso, MD. Some patients don't report the problem, assuming they simply gained weight after the procedure. It's easy to imagine this scenario unfolding in cases where patients haven't been briefed on the risks of CoolSculpting prior to treatment. While the informed consent process is standard in doctors' offices, this review of risks and benefits may be skipped altogether when CoolSculpting is performed in a med spa or salon.
'CoolSculpting, rightfully, has gotten some very bad press, and the risks associated with it have become much more apparent, so I think people are less likely to perceive it as this risk-free way to have body contouring,' says Dr. Smith. 'Not only are fewer people turning to CoolSculpting [due to the risks], even in a vacuum, but very few post GLP-1 weight-loss patients are good candidates for the procedure,' he continues. 'And since CoolSculpting does, or did, account for such a large proportion of the noninvasive fat-removal market, that will account for a significant portion of the overall decline' in the category. Allure reached out to the manufacturers of CoolSculpting, who did not send a comment by press time.
In 2024, Dr. Smith co-authored the largest case series of PAH to date. Published in the Aesthetic Surgery Journal (ASJ), the paper details the cases of 33 patients with the complication. All required power-assisted liposuction, which pairs vibration with suction for more efficient fat removal; one patient, who'd undergone six rounds of CoolSculpting, needed a tummy tuck in addition to lipo. Twenty-eight percent of study subjects required multiple surgeries to correct their PAH.
The study highlights the case of a 30-year-old, who developed PAH after having her inner thighs treated at a med spa. When she returned to the spa for help, the technician attempted to solve the problem with the only tools at her disposal—more CoolSculpting plus two rounds of fat-dissolving deoxycholic acid injections (aka Kybella). When those interventions failed, the woman took it upon herself to consult with a plastic surgeon about a more effective strategy for correcting PAH: Surgery, the very thing she was aiming to avoid when she signed up for CoolSculpting.
'It is unfortunate and ironic that patients seeking a noninvasive body contouring treatment are those left with potentially severe contour deformities necessitating aggressive surgical management for resolution,' Dr. Matarasso says. If you're considering CoolSculpting or any noninvasive fat reduction procedure, it's best to see an experienced board-certified plastic surgeon or dermatologist, who acknowledges all of the potential risks and complications and is fully equipped to manage them should they occur.
Read more about body contouring and plastic surgery:
The Most Popular Plastic Surgery Procedure Says a Lot About Our Culture Right Now
17 People Get Real About Their Mommy Makeovers
Linda Evangelista Shared the First Photos of Her Body Following a Cosmetic Procedure Gone Wrong
Originally Appeared on Allure
